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Reviewed by Michael W. Smith, MD
Sept. 17, 2013 -- It's fall. The kids are back at school, college football rivalries are in high gear, and -- oh, yeah -- it’s time to get a flu vaccine.
In the past, flu protection basically boiled down to a choice between a shot or a sniff of a nasal spray. But this year there are new options. Some may protect you from additional strains of flu, while others make getting vaccinated a little easier. Read on to find out which may be best for you and your family.
These are the traditional flu shots. They prime the immune system to fight three strains of flu viruses, two "A" strains and one "B" strain. Each year, the FDA updates the recipe to include the kinds of flu they think will be most likely to make people sick during the coming season.
"They do a pretty good job of predicting what's going to be circulating" for the A strains, says Michael Brady, MD. He is an infectious disease specialist at Nationwide Children's Hospital in Ohio. The B strains, though, are harder to forecast. The FDA picks the right B strain about two-thirds of the time, Brady says.
It's too early to tell whether the FDA nailed the flu shot formula this year. When it's a close match, a flu shot can cut by more than half the chances that a person will need medical care for the flu, according to the CDC.
The newest way to ward off the flu, quadrivalent vaccines protect against four strains of the virus instead of three. Because these vaccines include two A and two B strains, they may give more protection, though this hasn't been proven.
"We didn't necessarily know that having four strains was better than having three," Brady says. That's one reason the American Academy of Pediatrics recently said that either option would be fine for kids this year.
All of the FluMist nasal sprays include four strains. Because FluMist is a weakened version of live flu virus, it's not recommended for everyone. Pregnant women, children or teens on an aspirin regimen, people with asthma or breathing problems, or those who have weak immune systems or chronic health conditions should not get FluMist.
There also are quadrivalent injections, which don't contain live virus.
"I would say take advantage of it, if it's available and it doesn't cost you extra out of pocket," says Wilbur Chen, MD. He is a clinical vaccinologist at the University of Maryland's Center for Vaccine Development in Baltimore.
Be aware, though: The new four-strain shots may be hard to find.
Doctors and pharmacists, who had to order vaccines back in February, may have ordered whatever was available at the time, so they may have mostly three-strain, Brady says. "And that's OK."
Seniors have a weaker response to vaccines than children and younger adults. Last year, for example, the traditional flu vaccine was about 65% effective in children, but only about 27% effective in people 65 and older, according to the CDC.
Studies have shown that giving higher doses may more effectively rouse an older immune system, so companies have begun to offer new high-dose flu shots. It’s a bid to improve protection for the elderly, who can catch the flu more easily and also tend to face the worst of its complications.
The high-dose flu shot contains four times as much active ingredient as a regular flu shot. It has been FDA-approved since 2009, but it’s not clear if the high-dose vaccine really offers more protection.
This year, though, Sanofi Pasteur says it has proof that the larger dose works better. In a news release issued in August, the company announced preliminary results of a clinical trial including more than 30,000 people over the age of 65 who were followed for two flu seasons. The company says the high dose was about 24% more effective at preventing flu than the traditional vaccine.
Most flu vaccines are made from eggs, so doctors have tended to caution those who are very allergic to eggs to steer clear.
But this year there's a new kind of vaccine that's not grown in eggs, so it can be safely taken by people who are very sensitive. "Now they have no excuse," Chen says.
Unfortunately, the egg-free vaccine is only approved for adults ages 18 to 49.
"The good news for parents is that for children who have egg allergies, unless they have severe reactions to eggs, they can be immunized with the currently available vaccines without any concerns or difficulties," Brady says.
Unless your child has anaphylaxis, which can stop breathing, most kids who are sensitive to eggs -- they itch or break out in hives, for example -- do just fine with the tiny amount found in vaccines, Brady says.
Vaccines Given With Smaller Needles
New intradermal flu vaccines go into the top layer of skin instead of the muscle, which means the needle can be 90% smaller than the kind used for a standard injection.
This is a good choice if needles make you queasy or you can't stomach the brief aftertaste of the nasal spray.
Like the egg-free vaccines, this one seems like it would be ideal for babies and kids, but it's approved only for adults 18 to 64.
SOURCES:Michael Brady, MD, physician in chief, Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.Wilbur Chen, MD, assistant professor of medicine, University of Maryland School of Medicine, Baltimore.CDC: "Summary Recommendations: Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices -United States-2013-2014."Morbidity and Mortality Weekly Report, Feb. 22, 2013.
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